NHS: something's gotta give - either targets or services

Following a recent report on stress levels in the public sector, Eifion Rees reports from the NHS frontline where the pressure to meet targets is having a detrimental affect on services - and employees' health

'The NHS used to be a pleasant place to work'. Managers are now finding that regularly working 10-hour days or more is the norm

Working in the public sector can seriously damage your health. That is the conclusion of research published recently in the European Heart Journal.

Conducted among 10,000 Whitehall civil servants, it found people who daily work three hours overtime or more were 60% more likely to suffer a heart attack than those working normal hours. Streamlining and cost-cutting have taken their toll: stress levels in the public sector are now said to be higher than in the private sector.Public expectation

Anne Gibson, head of HR at Norfolk county council and vice president of the Public Sector People Managers' Association, puts the increased potential for stress down to an increased number of challenges. "In terms of outcomes to deliver, there is certainly a greater demand to work faster and on a more complex range of issues," she says. This is partly down to an increase in public expectation about what they should get in terms of services, fuelled by changes in the commercial world, such as online banking.

Whatever the cause, the results include greater pressure than ever on senior managers in the public sector. One NHS manager says the work-life balance in her London PCT began tipping heavily in favour of the former some 18 months ago. She regularly works 50-hour weeks, spending lunch breaks in front of her computer or in meetings, and occasionally works at weekends.

"We're expected to do whatever is required to get the job done," she says. "In most NHS organisations, people leave and their responsibilities are shared out on an 'interim' basis among colleagues – that this becomes a permanent arrangement seems to be an unwritten rule."

Contributing to the atmosphere of stress, she adds, is a tendency towards "buck-passing" and away from taking ownership of tasks. Communication is also a factor, with a feeling that some managers are being "set up to fail" by being given too much work and not enough training.

"The NHS used to be a more pleasant place to work, but over time has become more challenging and politically driven, with minimal flexibility for negotiation over target delivery. We try to keep up morale and make time to chat, but with many gaps in the service and few resources to fill them, something will have to give, either targets or services."

Reduced to tears

Or, indeed, people. One community services manager in the south of England ascribes her stress to restructuring within her organisation, overseen by an interim chief operating officer with a "very abrasive, bullying" management style. "Clinicians who are also managers, as I am, are not always valued or supported to make the development change into whatever new type of manager our leaders want," she says. Management meetings became increasingly difficult as efficiency and productivity goals were pursued, she adds, with colleagues sometimes reduced to tears.

Regularly working 10-hour days or more since September, this manager began experiencing breathlessness and incipient feelings of panic, and was eventually diagnosed with work-related stress and signed off by her GP. She believes many public sector managers are unaware they, too, may have work-related stress. "If people are on edge, anxious about their futures and unsupported in their jobs, they can't focus on patient care," she comments. "Procedures are suffering, and a growing culture of interims means an increasing focus on upping performance to the detriment of forming relationships with colleagues and loyalty to the local areas and organisations.

"The public sector has changed – my colleagues and I used to laugh a lot more and go out for lunch together, which was always a supportive time. The caring aspect has reduced as we strive to meet targets."

Stephen Chaffey, a solicitor at law firm Dundas & Wilson, says work-related stress may have legal implications, as well as impacting an organisation's "bottom line" by increasing sickness absence and reducing productivity. "While there is no UK legislation focused solely on stress, employers are obliged under the Health and Safety at Work Act to provide a safe working environment for their employees," he points out. "They will be potentially liable for a breach of that duty if an injury to physical or mental health occurs related to stress."

Management standards issued by the Health and Safety Executive offer guidance in distinguishing between positive and excessive pressure, he adds.

Sign up for the Guardian Today

Our editors' picks for the day's top news and commentary delivered to your inbox each morning.

Comments

Society Professionals

Welcome to Society Professionals, a place for public-service experts to share news, views, ideas and innovation. Because the bigger the picture, the bigger the potential

Visit our society networks

About Guardian Professional

Guardian Professional Networks are community-focused sites, where we bring together advice, best practice and insight from a wide range of professional communities. Click here for details of all our networks. Some of our specialist hubs within these sites are supported by funding from external companies and organisations. All editorial content is independent of any sponsorship, unless otherwise clearly stated. We make Partner Zones available for sponsors' own content. Guardian Professional is a division of Guardian News & Media.